Review Article

TB and HIV Therapeutics: Pharmacology Research Priorities

Table 1

High-priority TB-HIV PK or PK/PD studies.

FDA approved TB drugs with ARVs

Rifampicin (RMP)
  (i) Evaluation of double-dose LPV/r (800/200 twice daily) among HIV/TB-coinfected adults taking RMP-containing TB treatment with focus on HIV viral suppression and hepatotoxicity
  (ii) Evaluation of super-boosted LPV (1: 1 LPV/r ratio with weight-based dosing) among HIV/TB-coinfected children receiving RMP-containing TB treatment with focus on LPV PK and HIV viral suppression
  (iii) Evaluation of EFV at 600 mg versus 800 mg daily among patients with HIV/TB-coinfection taking RMP-containing TB treatment who weigh more than 50 kg
  (iv) Evaluation of EFV or higher dose LPV/r among pregnant women with HIV/TB-coinfection taking RMP-containing TB treatment
  (v) Evaluation of double-dose RAL (800 mg twice daily) among HIV/TB-coinfected patients taking RMP-containing TB treatment
  (vi) Determination of dose of DRV/r likely to achieve target DRV concentrations among subjects taking RMP
  (vii) Evaluation of higher dose dolutegravir (50 mg twice daily) among HIV/TB-coinfected patients taking RMP-containing TB treatment

Rifapentine (RPT)
  (i) Drug interaction studies involving RPT at the optimized dose for TB treatment and key HIV drugs, namely, EFV, NVP, and ritonavir-boosted PIs
  (ii) Drug interaction studies with weekly RPT used for LTBI treatment and key ARVs including EFV, NVP, and ritonavir-boosted PIs among patients with HIV receiving ART
  (iii) Dose-finding PK study in infants and pediatric formulations

Rifabutin (RBT)
  (i) Evaluation of RBT at a dose of 150 mg daily among HIV-TB-coinfected patients taking LPV/r-based ART with a focus on RBT-related toxicities and HIV viral load suppression
  (ii) RBT formulations for children

Isoniazid (INH)
  (i) Studies of the effects of INH (alone) as treatment for LTBI on the kinetics of EFV and LPV/r

Select Tb drugs in the pipeline

AZD5847
  (i) PKI studies as appropriate once the dose to be tested in later-phase studies is determined and information regarding its metabolism and capacity to induce or inhibit P450 enzymes is publicly available

Bedaquiline (TMC207)
  (i) PK/PD studies among patients with TB/HIV coinfection taking bedaquiline-containing TB treatment and ART that includes EFV or NVP (multiple dose study)
  (ii) Dose-finding PK study in children with MDR-TB
  (iii) PKI with combined use of RMP and EFV with bedaquiline

Delamanid (OPC-67683)
  (i) No specific drug interaction studies currently recommended given low risk of metabolic drug interactions

PA-824
  (i) Drug interaction studies with RMP, EFV, and LPV/r with necessity of further studies to be determined by results of these trials of PA-824 given with a potent inducer (RMP) or potent inhibitor (ritonavir)

Sutezolid (PNU-100480)
  (i) Drug interaction study with RMP and perhaps key ARVs once dose to be tested in later-phase studies is determined, with measurement of parent drug and active metabolites
  (ii) Dose-finding PK study in children

SQ109
  (i) PKI study with RMP once the dose of SQ-109 to be tested in later-phase studies is determined